Question 1

During the nurse's initial assessment of a school-aged child,the child reports a pain level of 6 out of 10.The child is lying quietly in bed watching television.The nurse should:

Accepted Answer

The child reported a moderate level of pain and as a nurse, it is important to provide relief to the child. Administering the prescribed analgesic is the appropriate action in this scenario. The nurse should also reassess the child's pain level after administration of the medication to ensure adequate pain relief.

Question 2

The nurse is working in a pediatric surgical unit.In discussing patient-controlled analgesia (PCA)in a preop parental meeting,the nurse would explain that PCA is most appropriate for the:

Accepted Answer

PCA is most appropriate for patients who can understand and control the button to administer their pain medication. A 12-year-old postop spinal fusion for scoliosis is likely to have the cognitive ability and understanding necessary to manage PCA effectively, unlike younger children or those with developmental delays.

Question 3

A 5-year-old is hospitalized with a fractured femur.Which of the following assessment tools are appropriate for this age child? Select all that apply.

Accepted Answer

The Faces Pain Scale, Oucher Scale, and Poker Chip Tool are appropriate for assessing pain in a 5-year-old child. The Faces Pain Scale uses facial expressions to help children articulate their pain levels. The Oucher Scale combines photographs of children's faces showing different levels of pain with a numerical scale, suitable for young children who can point to a picture that matches their pain level. The Poker Chip Tool uses "pieces of hurt" as a concept where children can use poker chips to represent the intensity of their pain, making it suitable for their developmental level. The Visual Analog Scale is generally more suitable for older children and adults who can understand and accurately place their pain on a "no pain" to "worst pain" continuum. The CRIES scale is specifically designed for neonatal pain assessment, not for a 5-year-old.

Question 4

As an advocate for the child undergoing bone marrow aspiration,the nurse would most appropriately suggest:

Accepted Answer

Sedation prior to and during the procedure is the most appropriate suggestion for a child undergoing bone marrow aspiration. This allows for the child to be relaxed and comfortable during the procedure, which is important for a successful procedure and to reduce anxiety and fear in the child. General anesthesia may not be necessary and has more risks, while intravenous narcotics may not be enough to manage pain during the procedure. Oral pain medication may also not be enough for pain management after the procedure.

Question 5

The nurse is admitting an 8-year-old Vietnamese child who hit a parked car while riding a bike.The child has a fracture of the left radius and femur in addition to a fractured orbit.The child is stoic,and denies pain.The most appropriate initial action by the nurse is to:

Accepted Answer

Administering pain medication immediately and continuing on a regular basis is crucial for managing pain in a child who may be stoic due to cultural reasons or personal pain tolerance. The child's denial of pain does not negate the need for pain management, especially with significant injuries such as fractures. The FLACC scale is more appropriate for non-verbal children or those who cannot communicate their pain effectively, and relying on the child or parents to report pain may delay necessary pain management.

Question 6

A 3-year-old is hospitalized following surgery for a ruptured appendix.Opioids were administered postoperatively to relieve pain.During assessment of the child,the nurse notes that the child is sleeping.Vital signs are as follows: temperature 97.8$\degree$F axillary,pulse 90,respirations 12,and blood pressure 100/60.Based on this assessment,the nurse concludes that the child is:

Accepted Answer

The child's respiratory rate of 12 is lower than the normal range for a 3-year-old, which can indicate respiratory depression, a common side effect of opioid administration.

Question 7

The nurse is caring for a child who has a long leg cast.The child complains of increasing pain in the toes of the foot in the cast.The nurse's initial action is to:

Accepted Answer

The most likely cause of pain in the toes of a child with a long leg cast is that the cast is too tight, so the nurse should check this first. If the cast is too tight, it can lead to circulation problems or nerve damage, so it needs to be corrected promptly. The nurse should also assess for other potential causes of pain, such as pressure sores or muscle spasms, but checking the tightness of the cast should be the first priority. Calling the physician or administering pain medication may be necessary if the cast is too tight or if other interventions do not relieve the pain, but they are not the initial actions to take. Repositioning the child in bed may also be helpful in relieving discomfort, but it is not as urgent as checking the cast.

Question 8

The nurse is preparing to perform a heel stick on a newborn.The most appropriate complementary therapy for the nurse to plan to use for the newborn to decrease pain during this quick but painful procedure is:

Accepted Answer

Research has shown that sucrose can be an effective pain management strategy for newborns during minor procedures such as heel sticks. Swaddling, massage, and holding can also be beneficial, but may not have as significant an effect on reducing pain during the procedure.

Question 9

A 10-year-old has been receiving morphine every 2 hours for postoperative pain as ordered.The medication relieves the pain for approximately 90 minutes and then the pain returns.The nurse should:

Accepted Answer

The best choice would be to call the physician to see if the child's orders for pain medication can be changed. The current medication regimen is not providing adequate pain relief for the child, and it may be necessary to adjust the dose or frequency of administration. It is important to address the child's pain management needs and ensure that they are comfortable during the recovery process.

Question 10

A parent asks the nurse if there is anything that can be done to reduce the pain that his 3-year-old experiences each morning when blood is drawn for lab studies.The most appropriate method the nurse can suggest to relieve pain associated with the venipuncture is:

Accepted Answer

EMLA cream is a topical anesthetic cream that can be applied to the skin at least 1 hour prior to the procedure, which can reduce the pain associated with venipuncture. Intravenous sedation may not be appropriate for a 3-year-old child and muscle-relaxation techniques and guided imagery may not be effective for reducing the pain associated with venipuncture.

Question 11

The nurse is caring for a child who has been sedated for a painful procedure.The priority nursing activity for this child is:

Accepted Answer

The priority is to assess the child's respiratory effort, as sedation can depress respiratory function, which is critical to monitor to ensure the child's safety.

Question 12

A 2-year-old is hospitalized with a fractured femur.In addition to pain medication,which of the following will best provide pain relief for this child?

Accepted Answer

Parents' presence at the bedside provides comfort and a sense of security for the child, which can help reduce pain and anxiety. Age-appropriate toys, deep-breathing exercises, and videos may be helpful distractions, but they do not provide the same level of comfort and reassurance as the presence of a trusted caregiver.

Question 13

A 5-year-old is being discharged from the outpatient surgical center.Which statement by the parent would indicate the need for further teaching?

Accepted Answer

This statement is incorrect as pain typically peaks within the first 24-48 hours after surgery and then gradually subsides. If the pain level is higher the day after surgery, this may indicate a complication and the parent should seek medical attention.

Question 14

The nurse is caring for a 2-year-old child in the postoperative period.The pain assessment tool most appropriate for assessment of pain intensity in a 2-year-old is the:

Accepted Answer

The FLACC behavioral pain assessment scale is the most appropriate tool for assessing pain in children between the ages of 2 months and 7 years who are unable to communicate their pain verbally. It assesses five areas: facial expression, leg movement, activity level, cry, and consolability. The nurse can use this tool to determine the child's level of pain and the effectiveness of pain management interventions. The other tools listed are more appropriate for older children who are able to use language to describe their pain.

Question 15

A hospitalized 3-year-old needs to have an IV restarted.The child begins to cry when carried into the treatment room by the mother.The most appropriate nursing diagnosis is:

Accepted Answer

The child's crying upon being carried into the treatment room, where they likely associate previous painful experiences (such as IV insertions), indicates anxiety related to anticipating another painful procedure. This response is typical for a child who has experienced discomfort during medical treatments and anticipates it again.

Quiz 42: Pain Assessment and Management in Children